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General NPI Number Information
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NPI Number | 1548764665
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Entity Type | Organization
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Legal Business Name | ISLAND BODY WORKS LLC
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Dates
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Enumeration Date | 03/22/2018
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Last Update Date | 12/03/2018
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Provider Practice Location Address
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Address Line | 2423 GRAND ISLAND BLVD.
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City | GRAND ISLAND
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State | NY
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Zip | 14072-2967
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Country | US
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Telephone | 716-773-3300
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Fax | 716-773-3303
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Provider Business Mailing Address
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Address Line | 2423 GRAND ISLAND BLVD.
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City | GRAND ISLAND
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State | NY
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Zip | 14072-2967
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Country | US
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Telephone | 716-773-3300
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Fax | 716-773-3303
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LISA ZIMMER TRUNZO
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Credential | P.T.
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Telephone | 716-773-3300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 013305-1
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License Number State | NY
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